“Just because people are old, just because they're ill…” dignity matters in district nursing

Purpose This paper aims to explore the concept and practice, of dignity as understood and experienced by older adults and district nursing staff. The paper adds a new, nuanced, understanding of safeguarding possibilities in the context of district nursing care delivered in the home. Design/methodology/approach The research used an ethnographic methodology involving observations of care between community district nursing clinicians and patients (n = 62) and semi-structured interviews with nursing staff (n = 11) and older adult recipients of district nursing care (n = 11) in England. Findings Abuse is less likely to occur when clinicians are maintaining the dignity of their patients. The themes of time and space are used to demonstrate some fundamental ways in which dignity manifests. The absence of dignity offers opportunities for abuse and neglect to thrive; therefore, both time and space are essential safeguarding considerations. Dignity is influenced by time and how it is experienced temporally, but nurses are not allocated time to “do dignity”, an arguably essential component of the caregiving role, yet one that can become marginalised. The home-clinic exists as a clinical space requiring careful management to ensure it is also an environment of dignity that can safeguard older adults. Practical implications District nurses have both a proactive and reactive role in ensuring their patients remain safeguarded. By ensuring care is delivered with dignity and taking appropriate action if they suspect abuse or neglect, district nurses can safeguard their patients. Originality/value This paper begins to address an omission in existing empirical research regarding the role of district nursing teams in delivering dignified care and how this can safeguard older adults.

The Impact of COVID-19 from the Perspectives of Dutch District Nurses: A Mixed-Methods Study

Little is known about how COVID-19 affects older patients living at home or how it affects district nursing teams providing care to these patients. This study aims to (1) explore, from the perspectives of Dutch district nurses, COVID-19′s impact on patients receiving district nursing care, district nursing teams, and their organisations during the first outbreak in March 2020 as well as one year later; and (2) identify the needs of district nurses regarding future outbreaks. A mixed-methods, two-phase, sequential exploratory design was followed. In total, 36 district nurses were interviewed during the first outbreak (March 2020), of which 18 participated in the follow-up questionnaire in April 2021. Thirteen themes emerged, which showed that the COVID pandemic has substantially impacted patient care and district nursing teams. During the first outbreak, nurses played a crucial role in organising care differently and worked under high pressure, leading to exhaustion, tiredness, and psychosocial problems, including fear of infection. A year later, nurses were better prepared to provide COVID care, but problems regarding work pressure and mental complaints remained. The identified needs focus on a sustainable implementation of leadership roles for district nurses. At the organisational and national levels, more support and appreciation are needed in terms of trust and appropriate policies.

Book Review: International Practice Development in Health and Social Care (2nd Edition)

I was asked to review this book in my role as a clinical educator and novice practice developer. My introduction to practice development and person-centred practice came through the 2019 Inspire Improvement Fellowship, run by the Foundation of Nursing Studies, and through my work as a practice teacher for student specialist practitioner district nurses at Queen Margaret University, Edinburgh. My initial thoughts were how relatable this book is to me in practice. It is up to date, with references to Covid-19 and the WHO’s Year of the Nurse and Midwife 2020. The first part explores the theory of practice development and this follows through to later chapters where readers will find the application of theoretical ideas in practice. Practice development is explored at micro, meso and macro levels, supported by the book’s progression from smaller, ward-based projects to large system-based interventions. The evolution of practice development is also evident, moving from its origins within nursing to multidisciplinary and interagency approaches and contexts. I found it useful that chapters flowed through themes, with the final chapters focusing on leadership, workplace cultures and wellbeing, which are currently hot topics in the ever-changing landscape of health and social care. A wide range of references is helpfully used throughout to encourage more in-depth analysis and further reading.

Everyday District Nurses' Experiences Revealed Through Distillation: Palliative Care in the Community - an Action Research Project

<p>Distillation is used to extract and reveal essential oils and essences. Action research is a methodology that enables distillation of nurses' experiences, to reveal previously unseen elements and essences of nursing care, to identify issues and to extract tangible change or action outcomes. This modified action research inquiry focused on the everyday, palliative care practice experiences of a group of district nurses. The intent was to develop an understanding of common issues of concern for this group of district nurses when providing palliative home care in a specific community context and to implement practical, achievable strategies in response to these local issues. Five district nurses identified four broad areas for action through four praxis group meetings and comprising one full cycle. These four areas have been named as methods of enhancing support for people and families, possibilities for creatively managing workloads, mechanisms to enrich working partnership with other palliative care providers and possible vehicles for supporting nurses' self care. Implementation of action from this action research project focused on enhancing care and outcomes for people and family served by this group of district nurses in their local community. This study illuminates everyday essences of the district nurse role and the elements articulated by this group in supporting their practice in one New Zealand community. This study also reveals some of the tensions and messiness when employing an action research methodology with nurses in the workplace. This research focused on a little known area (palliative care delivered by district nurses in New Zealand) in a local community (a culturally vibrant and ethnically diverse yet with poor health and socioeconomic statistics). It has resonance with other nurses, particularly those working in community settings who may experience similar issues and concerns. This research also offers important insights for nurses working in any practice setting, with a desire to unpick and distill local issues they encounter - to take action and make a difference.</p>

Everyday District Nurses' Experiences Revealed Through Distillation: Palliative Care in the Community - an Action Research Project

<p>Distillation is used to extract and reveal essential oils and essences. Action research is a methodology that enables distillation of nurses' experiences, to reveal previously unseen elements and essences of nursing care, to identify issues and to extract tangible change or action outcomes. This modified action research inquiry focused on the everyday, palliative care practice experiences of a group of district nurses. The intent was to develop an understanding of common issues of concern for this group of district nurses when providing palliative home care in a specific community context and to implement practical, achievable strategies in response to these local issues. Five district nurses identified four broad areas for action through four praxis group meetings and comprising one full cycle. These four areas have been named as methods of enhancing support for people and families, possibilities for creatively managing workloads, mechanisms to enrich working partnership with other palliative care providers and possible vehicles for supporting nurses' self care. Implementation of action from this action research project focused on enhancing care and outcomes for people and family served by this group of district nurses in their local community. This study illuminates everyday essences of the district nurse role and the elements articulated by this group in supporting their practice in one New Zealand community. This study also reveals some of the tensions and messiness when employing an action research methodology with nurses in the workplace. This research focused on a little known area (palliative care delivered by district nurses in New Zealand) in a local community (a culturally vibrant and ethnically diverse yet with poor health and socioeconomic statistics). It has resonance with other nurses, particularly those working in community settings who may experience similar issues and concerns. This research also offers important insights for nurses working in any practice setting, with a desire to unpick and distill local issues they encounter - to take action and make a difference.</p>

Nurse Talk: Features of Effective Verbal Communication Used by Expert District Nurses

<p><b>This thesis represents an appreciative enquiry to identify features of effective verbal communication between nurses and patients.</b></p> <p>Using a method developed by the Language in the Workplace Project (Stubbe 1998) two nurse participants recorded a small sample of their conversations with patients as they occurred naturally in clinical practice. These six conversations constitute the main body of raw data for the study. The data was analysed using a combination of discourse and ethnographic analysis.</p> <p>Experience in nursing, particularly insider knowledge of the context of district nursing, helped me to uncover the richness of meaning in the conversations. The subtle interconnections and nuances could easily have been missed by an outside observer.</p> <p>The study has shown that in their interactions with patients, expert nurses follow a pattern in terms of the structure and content of the conversations and it is possible to identify specific features of effective nurse-patient communication within these conversations. The most significant of these are the repertoire of linguistic skills available to nurses, the importance of small talk and the attention paid by nurses to building a working relationship with patients, in part, through conversation.</p> <p>The findings have implications for nursing education and professional development.</p>

Nurse Talk: Features of Effective Verbal Communication Used by Expert District Nurses

<p><b>This thesis represents an appreciative enquiry to identify features of effective verbal communication between nurses and patients.</b></p> <p>Using a method developed by the Language in the Workplace Project (Stubbe 1998) two nurse participants recorded a small sample of their conversations with patients as they occurred naturally in clinical practice. These six conversations constitute the main body of raw data for the study. The data was analysed using a combination of discourse and ethnographic analysis.</p> <p>Experience in nursing, particularly insider knowledge of the context of district nursing, helped me to uncover the richness of meaning in the conversations. The subtle interconnections and nuances could easily have been missed by an outside observer.</p> <p>The study has shown that in their interactions with patients, expert nurses follow a pattern in terms of the structure and content of the conversations and it is possible to identify specific features of effective nurse-patient communication within these conversations. The most significant of these are the repertoire of linguistic skills available to nurses, the importance of small talk and the attention paid by nurses to building a working relationship with patients, in part, through conversation.</p> <p>The findings have implications for nursing education and professional development.</p>

How district nurses can support team wellbeing during the pandemic and beyond

The COVID-19 pandemic has required rapid adaptation of the community nursing service, including the introduction of online communication platforms to prevent COVID-19 transmission among staff. Remote working has protected the workforce in the community from being decimated through team sickness, but has resulted in nurses who are feeling anxious and isolated from their colleagues while experiencing increased workloads, with complex and often emotionally challenging situations. The pressures of community nursing and the associated impact on sickness absence relating to mental health are well documented. The resources made available to support staff wellbeing were increased during the pandemic, but there remains some disparity of access to these resources. There is much that can be done by the district nurse as a leader of a team to ensure that the pressures are managed in a way that promotes team cohesion and mutual respect, while ensuring that open communication about wellbeing is encouraged.

Why community specialist practitioner district nurses should promote tissue donation

A high proportion of patients are being supported with end-of-life (EoL) care in the community, many of which are known to district nursing (DN) caseloads. Over time, community specialist practitioner district nursing (CSPDN) teams build therapeutic relationships with patients, and they are adept at providing EoL care. They are also now actively and routinely undertaking verification of death (VoD). Thus, they are in a prime position to promote and facilitate community tissue donation among patients and their families. The Government has recognised a need to promote organ and tissue donation, implementing the Organ Donation (Deemed Consent) Act (2019) , whereby every person over the age of 18 years is now considered for organ and tissue donation with the anticipation of more recipients receiving life-changing tissue transplantation. DN teams seem to lack awareness of the change in law and, therefore, are not actively promoting this in practice. Further, there is no available community-focused guidance or training to support DNs to have these difficult and complex conversations enabling exploration of patients' wishes with regard to promote tissue donation. Therefore, guidance and education are needed in order to improve overall referrals, in the hope that they lead to an increase in donation.